Use of HER2-Directed Therapy in Metastatic Breast Cancer and How Community Physicians Collaborate to Improve Care
Abstract
:1. Introduction
2. HER2 and Breast Cancer
3. Assessment of HER2 Status
4. Functional Imaging to Predict Response to HER2 Therapies
5. Current Treatment for Metastatic HER2-Positive Breast Cancer
6. HER2 Activating Mutations—A Unique Clinical Entity
7. Engaging the Community in Clinical Research
8. Optimizing Partnerships
9. Future Directions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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HR− and HER2+ Breast Cancer | HR+ and HER2+ Breast Cancer |
FIRST: Biopsy confirmation of Diagnosis and Receptor Status ALL Pt should have BRCA tested | |
1st line #19339 NRG Trial pertuzumab, trastuzumab, taxane +/− atezolizumab | 1st line #19339 NRG Trial pertuzumab, trastuzumab, taxane +/− atezolizumab |
1st Line* pertuzumab, trastuzumab and taxane | 1st Line* pertuzumab, trastuzumab and taxane |
* #20048 Alpelisib in maintenance alpelisib combination in PIK3CA mutation | * #20048 Alpelisib in maintenance alpelisib combination in PIK3CA mutation |
2nd Line #19599 (HER2CLIMB-02) tucatinib or placebo in combination with TDM1 for unresectable locally-advanced or metastatic disease | 2nd Line #19599 (HER2CLIMB-02) tucatinib or placebo in combination with TDM1 for unresectable locally-advanced or metastatic disease |
2nd Line TDM1or tucatinib/capecitabine/trastuzumab | 2nd Line TDM1 or tucatinib/capecitabine/trastuzumab |
3rd Line tucatinib/capecitabine/trastuzumab or fam-trastuzumab-deruxtecan | 3rd Line tucatinib/capecitabine/trastuzumab or or fam-trastuzumab-deruxtecan |
4th or + Line Prior pertuzumab, trastuzumab, TDM1 consider fam-trastuzumab-deruxtecan or neratinib/capecitabine, lapatinib/trastuzumab Chemo + trastuzumab | 4th or + Line Prior pertuzumab, trastuzumab, TDM1 consider fam-trastuzumab-deruxtecan or neratinib/capecitabine, lapatinib/trastuzumab or Chemo + trastuzumab or an AI or LHRH agonist + Tamoxifen/trastuzumab |
Bone Directed Therapy— Zometa q1 month x 9, then q3 months until Hospice or Xgeva q1 month until Hospice (Xgeva is 2x more expensive) |
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Mortimer, J.E.; Kruper, L.; Cianfrocca, M.; Lavasani, S.; Liu, S.; Tank-Patel, N.; Sedrak, M.; Smith, W.; Stewart, D.; Waisman, J.; et al. Use of HER2-Directed Therapy in Metastatic Breast Cancer and How Community Physicians Collaborate to Improve Care. J. Clin. Med. 2020, 9, 1984. https://doi.org/10.3390/jcm9061984
Mortimer JE, Kruper L, Cianfrocca M, Lavasani S, Liu S, Tank-Patel N, Sedrak M, Smith W, Stewart D, Waisman J, et al. Use of HER2-Directed Therapy in Metastatic Breast Cancer and How Community Physicians Collaborate to Improve Care. Journal of Clinical Medicine. 2020; 9(6):1984. https://doi.org/10.3390/jcm9061984
Chicago/Turabian StyleMortimer, Joanne E., Laura Kruper, Mary Cianfrocca, Sayeh Lavasani, Sariah Liu, Niki Tank-Patel, Mina Sedrak, Wade Smith, Daphne Stewart, James Waisman, and et al. 2020. "Use of HER2-Directed Therapy in Metastatic Breast Cancer and How Community Physicians Collaborate to Improve Care" Journal of Clinical Medicine 9, no. 6: 1984. https://doi.org/10.3390/jcm9061984
APA StyleMortimer, J. E., Kruper, L., Cianfrocca, M., Lavasani, S., Liu, S., Tank-Patel, N., Sedrak, M., Smith, W., Stewart, D., Waisman, J., Yeon, C., Wang, T., & Yuan, Y. (2020). Use of HER2-Directed Therapy in Metastatic Breast Cancer and How Community Physicians Collaborate to Improve Care. Journal of Clinical Medicine, 9(6), 1984. https://doi.org/10.3390/jcm9061984